- Cleveland Clinic Abu Dhabi’s ophthalmologist likens ocular injuries in children by ingredients in hand sanitizers to those suffered by workers exposed to chemical spills on worksites
A doctor at Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, has sounded the alarm on severe ocular injuries in children caused by the unintentional exposure to hand sanitizers from self-dispensing units after the care team at the hospital successfully treated a four-year-old child with severe damage to her cornea.
The accident occurred when the child activated a foot-operated hand sanitizer station installed in a public place that she was visiting with her family and got hand sanitizer gel in her eye.
Her mother, who wishes to remain anonymous, says that not many people are aware of chemicals in hand sanitizers that could be dangerous, especially for children.
“For purposes of hygiene, we’ve taught our daughter to use soap and water for washing her hands and to only use sanitizers if soap and water are not available, but because she saw everyone around her use it, she ran up ahead from us to use it too. When she pressed the pedal of the dispenser, the hand sanitizer didn’t fall downwards but instead a large amount went straight into her eye and she began screaming in pain,” she says.
Her parents immediately irrigated her eye with water and took her home whilst continuing to wash her eye out. “We somehow were able to open her eye and we could clearly see the corneal injury. That’s when we decided to rush her to Cleveland Clinic Abu Dhabi because of their expertise in pediatric ophthalmology, and trusted that they’d know how to treat this specific case,” she adds.
The child presented to the Emergency Department at Cleveland Clinic Abu Dhabi with extreme pain and inability to open her eye. Doctors immediately washed the solution from the child’s eye, administered antibiotics to prevent infection and pain drops to reduce discomfort. She was diagnosed with a near total corneal abrasion caused by the alcohol and alkaline chemical additives in the hand gel. When the pain continued to escalate despite close follow-up over the following days by caregivers from Cleveland Clinic Abu Dhabi’s Eye Institute, the child was taken to the operating room where doctors evaluated her eye under anesthesia and placed a self-retaining amniotic membrane, or biological bandage used to heal large non-healing corneal abrasions.
Dr. Brian Armstrong, a Staff Physician in the Eye Institute at Cleveland Clinic Abu Dhabi, who was part of the care team that treated the child, says this was the first such case of this nature that they have treated at the hospital that required amniotic membrane placement, but pediatric eye injuries from alcohol-based hand sanitizers have been on the rise around the world since the start of the pandemic. Earlier this year, the French Poison Control Centers reported seven times more cases of ocular exposure among children to hand sanitizers between April and August in 2020 compared to the same period in 2019.
“Hand sanitizer dispensers installed in public spaces are often at waist-level for adults but this means that they are at eye-level for children. So, the chances of a child getting splashed in the eye are quite high. Most hand sanitizers have a high concentration of alcohol, which starts to break down the surface of the cornea immediately. We use it in very measured doses to treat the cornea in very specific instances, so we know just how effective it can be.” says Dr. Armstrong.
“With this child, the pain may have increased over time as the alkaline solution penetrated deeper into her cornea. Immediate irrigation is advised in these cases, and manual opening of the eye may be required. It is important to irrigate away from the unaffected eye to prevent any further damage,” he explains.
Doctors removed the amniotic membrane a week after it was placed and found the corneal abrasion to be completely healed. However, the cornea was very dry and hazy, so doctors prescribed a course of medicated and lubricant eye drops. At the child’s next follow-up visit, the remaining findings had fully resolved. Her care team at Cleveland Clinic Abu Dhabi will continue to follow her progress for the next few months.
“This is the kind of injury we would typically see among workers who are exposed to toxic materials or a chemical spill on a worksite. Delayed treatment of such injuries can have even worse repercussions in children compared to adults because their vision is still developing at such a young age. The risk of amblyopia, where vision fails to develop properly, is much higher at this age. The likelihood of complications following corneal transplantation, if necessary, is also much higher at this age.”
Dr. Armstrong advises parents to use soap and water preferably over hand sanitizer with their children wherever possible. “If this is not possible, parents should use neutral and natural hand sanitizing solutions under strict supervision and teach their children to use only a small amount making sure it completely dries prior to touching their eyes. If they happen to rub their eyes with sanitizer, immediately wash it out with water and visit a hospital if there is blurred vision or pain.”
The child’s mother says the positive outcome was a result of swift action by them and the hospital. “If treatment was delayed, this could have caused permanent vision damage. I really appreciate the prompt response of the emergency and ophthalmology teams at Cleveland Clinic Abu Dhabi and thank them for the attention and care that helped save my daughter’s eye.”
She adds: “Along with raising awareness among parents about the dangers of hand sanitizers for children, I’d like to advise them to take their children’s complaint about pain seriously and visit a hospital to avoid major problems.”
For more information or to book an appointment at Cleveland Clinic Abu Dhabi, call 800 8 CCAD (2223) visit www.clevelandclinicabudhabi.ae or download the Cleveland Clinic Abu Dhabi app.